Doctor's Orders: Don't Review Me Online

from the stifling dept

The local review site Yelp has been under fire lately from some businesses that aren't happy with reviews people have written about them, or how they're displayed on the site. Not that this is anything new: people have sued the site for defamation before, while others have tried to game the system to make their businesses look more popular. But now, some doctors are trying to get patients to sign waivers saying they won't post comments about their doctors online (via Information Week). A company has set up a service that provides doctors with the waivers, then monitors review sites for comments about them. If they find a comment on one of the subscribing doctors, they attempt to use the waivers to get the sites to remove it. Of course, most of the comments are anonymous, so it's not clear exactly how they link a particular comment to a particular patient who's signed a waiver, and at least one site has refused to comply.

The founder of the service says the only thing that should matter to patients are a doctor's medical skills -- but that hardly seems true. Certainly they play a large role in determining a patient's happiness with their care, but there's the oft-referred-to "bedside manner" that also plays key part. Consumers have the right to as much information about their medical caregivers as they need to feel comfortable, but it can often be difficult to ascertain. That seems to play into doctors' hands, so it's hard to see these attempts to gag patients as little more than a further attempt to stifle anything that challenges the status quo in the world of medicine.

Truth: Binary v. Continuum

As I see it, this is just another clash between the old school mentality that anything in print must be true and the more modern attitude of natural skepticism of any information regardless of whether it's in print or not.

In other words, I think the doctors are coming from a perspective (and an era) that Truth (tm) is binary. ("If it's in print, it's true and if it's not true, we can sue.") But the more modern attitude is to view Truth on a continuum where, on one end, you have anonymous comments on web site you've never heard of and, on the other end, you have seeing something with your own two eyes.

People that have (even partially) grown up with the Internet just automatically gauge their level of trust in any source of information. It's second nature. Not to excuse the doctors here, but they're freaking out because they're applying the old (and outdated) binary model of Truth. In short, they just need to deal with the new reality that the responsibility for determining Truth (or how much trust you have in a source) is no longer in the hands of the few.

It is interesting that anyone would say that bedside manner is irrelevant.

Furthermore, as Mike already alluded to, there is something called informed consent, which gives patients the right to know everything they need to about their health care and their health care providers as it relates to providing health care. Doctor's acting to cover up these reviews are violating the principle of informed consent.

Lastly, doctor-patient confidentiality is for the benefit of the patient and not the doctor; it does not go both ways. Asking patients to sign an NDA goes against what it is to be a doctor, and furthermore if a patient refuses then what? Doctors have a responsibility to not frivolously drop/hand-off patients.

I'd also like to add that there are a lot of asshole doctors out there, and there is little that can be done when a doctor is simply a jerk. I am in support of any service that tries to correct this problem.

While the doctor may believe its perfectly ok to treat a patient with little, if any, respect, the patient may feel otherwise and has a perfect right to voice their opinion of the care and treatment they receive. Please don't misunderstand, many, hopefully most, doctors treat their patients with care and kindness, but some don't. When this happens, a patient should not feel obligated to keep their opinion regarding that treatment to themselves. Its the whole word of mouth advertising gone high tech. Give a good experience, get good reviews, piss people off and they will piss you off.

fail

I do not see the proposal having any effect, in fact if the 'scare' people into signing something they will not post GOOD things about the dr either.. they will just stay away from the YELPs of the world. So all that will remain is the negative. someone with a chip on their shoulder are going to ignore the paper they signed and blast away.

Anyone who uses online rating systems as their sole source of important info is an idiot since they can be manipulated both ways. To me, the key is to look for consistencies in reviews and ratings and use that only as a part in the decision making process. If any industry is going to use rating systems I feel that medicine should be at the top of the list. Doctors earn a reputation (good or bad) whether it is word of mouth or online systems.

Doctors provide a service

Patients have a right to their opinion -- isn't Zagat doing something about rating hospitals? Anyhow, why would I want to see anyone with crappy bedside manner, and still have to pay for it? Most Drs. are supposed to have a kind outlook, but if Doctor's are so worried about a bad review they should monitor their behaviour accordingly. Sorry - I want to know if a Doctor I'm visiting does not have a computer and is a pack rat (it's true - I visited a private practice doctor with papers and x-rays everywhere) or smells like alcohol (another true story - it wasn't Listerine).

Lol, i just can't picture doctors making patients sign waivers.
"Well it looks like you have a spiral fracture extending the length of your distal tibia, i be sending you to the ER immediately, oh and would you mind signing this waiver saying you wont say bad things about me over the internet?

Don't ever doubt that good doctors have the power in the patient/doctor relationship. Good doctors can and do refuse to accept insurance or submit the paperwork, they make their customers pay for their services and get them to seek reimbursement from the insurance carrier.

Why do you think they say "the doctor will see you now"

Think about that. Most other "businesses" the customer is king. Here, we know the deal.

You think these doctors will accept the lower reimbursement from Medicare or universal coverage? Hahahaha. They won't. They will continue to only see those that can afford to pay and the rest of the "unwashed" that are on govt. payment systems will only have access to doctors that are not good enough to demand that.

Clinic Level

I encountered one of these forms at the Urgent Care Clinic that employs several doctors. I was told that I could not be seen until I signed the form. I pointed to the sign they have posted about the state's "Right to Medical Care" law. The clerk said that I wasn't being refused care; all I had to do was sign the form. I asked to speak to the manager, but one was not on duty. They got a doctor instead. He was furious when he saw the form. My son went to the clinic a couple of weeks ago and was never given the waiver.

One day you write about how a woman called the cops three times because McDonalds didn't have Chicken McNuggets.
And today you wonder why "service providers" don't want the public to share their views.

Is it really that big a mystery to you? End users are idiots.
They can get the best care in the world and still find something offensive about it.

"If one would give me six lines written by the hand of the most honest man, I would find something in them to have him hanged."
--Cardinal Richelieu

Re:

They can get the best care in the world and still find something offensive about it.

And you point is...what exactly? That because someone might post something on the Internet that (gasp!) isn't true or (surprise!) is stupid or (shudder!) offensive, that this shouldn't be allowed? We know that people post untrue/stupid/offensive things to the Internet and we judge it accordingly.

So, yeah, people are going to post biased or uninformed reviews online, but the right way to use these sites is to look for trends and to use them in conjuntion with other sources. There are ways to factor out idiocy.

"Secrecy is the first essential in affairs of state."
- Cardinal Richelieu
[And modern medicine too, apparently.]

HIPPA

There is a difference here, HIPPA (or whatever the actual acronym is). Most businesses can respond to ratings. Whether that is to deny, or explain the situation. HIPPA prevents a doctor from discussing this information in any way as that could be construed as violating HIPPA.

I understand the reactions to the waiver. However, the part of the story I found interesting was the service using the waiver to get Yelp to remove a review. Even assuming they could identify the person commenting, if Yelp is not party to that waiver, they are not bound by it. Any dispute is between the doctor and patient, and the doctor can try to enforce it against the patient. However, I do not see how it can enforce an agreement against Yelp to which Yelp is not a party.

Re: Re:

"And you point is...what exactly? That because someone might post something on the Internet that (gasp!) isn't true or (surprise!) is stupid or (shudder!) offensive, that this shouldn't be allowed?"

No you fucking simpleton.
But this freedom everyone is having a hardon about (and by the looks of it really doesn't understand) comes with the price of taking responsibility for ones own actions. And that is what the waiver can do. It can force the person who lies be held liable. They still have their freedom to say and do what they want. But now they might have to pay for it like they should.

"but the right way to use these sites is to look for trends and to use them in conjuntion with other sources"

Yeah, like my 80 year old grandma is going to give a flying fuck about trending in public opinion.
She is going to see a bad review and be scared the dude will rape her.

Re:

You think these doctors will accept the lower reimbursement from Medicare or universal coverage? Hahahaha. They won't. They will continue to only see those that can afford to pay and the rest of the "unwashed" that are on govt. payment systems will only have access to doctors that are not good enough to demand that.

That would be interesting if it were true, but it's not. In fact, Medicare typically pays doctors/hostpitals at a rate that is higher than most most insurance companies. If you are in the medical profession you WANT to accept medicare. Without it you're going to have to rely on your ability to negotiate favorable rates with the insurance carriers that you accept. Except that most insurance carriers will not allow you to bill them for services unless you're accredited by JCAHO, which incidentally is the same organization that has to accredit your organization to allow you to bill Medicare. See how that works?

I have no doubt that there are some doctors that only deal with "self-insured" patients. But there are so few "self-insured" patients that can actually afford services (in many cases "self-insured is a euphemism for "no insurance and no ability to pay") that it's probably fairly hard to make a living. Unless you're a cosmetic surgeon in Beverly Hills or something, of course. The problem with the "self-insured" is that they end up getting billed full list price for procedures, whereas insured and Medicare patients get discounted rates, of which they usually only pay a deductible or co-pay.

Re: Re:

I wish my previous doctor had been reviewed on Yelp -- it would have saved me a lot of frustration, him being such an arrogant prick. My current doctor is kind and gentle and will get a glowing review from me. If your doctor wants you to sign an NDA...yeah, time to find a new one.

Re:

Re: HIPPA

There is a difference here, HIPPA (or whatever the actual acronym is). Most businesses can respond to ratings. Whether that is to deny, or explain the situation. HIPPA prevents a doctor from discussing this information in any way as that could be construed as violating HIPPA.

It may surprise you to know that these sorts of lists have existed for years, and were available to hospitals and other provider organizations by subscription as a way to weed out bad doctors. Those subscription services still exist to this day, even though HIPAA (spelled correctly) similarly prevents the physicians from responding. The only real objection here is the added layer of transparency by allowing the public to see and create reviews of physicians.

But here is the much larger problem for the physician. Many of them have a god complex, and some of them treat their patients poorly (not the same as providing poor care). This is certainly a customer service issue, but it's also a potential litigation issue. There are a number of studies that demonstrate quite clearly that doctors who spend more time with their patients and are perceived to have a "better" bedside manner are far less likely to ever be sued of malpractice, even when they have made a mistake that would be cause for suit. Treating your patients with kindness and respect is the cheapest form of malpractice insurance there is, even in this litigious society. A sensible doctor would look at this as an opportunity to use patient feedback improve their practice, but they don't.

Re: Re: Re:

"But this freedom everyone is having a hardon about (and by the looks of it really doesn't understand) comes with the price of taking responsibility for ones own actions. And that is what the waiver can do. It can force the person who lies be held liable. They still have their freedom to say and do what they want. But now they might have to pay for it like they should."

You're forgetting something... If the patient signs a waiver stating that they won't say anything online about the doctor, then the doctor can sue them *even if what the patient has said online is true*. The waiver doesn't make liars accountable, it gags all patients whether they're lying or not.

Personally, if asked to sign such a waiver, I would refuse. If the doctor then refused to see me because I didn't sign the waiver, then I would be sure to let the world at large know about it (via the internet). After all, shouldn't doctors be held responsible for their actions as well?

Re: Re: Re:

Maybe us fucking simpletons wouldn't have to guess what your point is if you actually, you know, made one in your original post instead of having to in a follow-up.

But this freedom everyone is having a hardon about (and by the looks of it really doesn't understand) comes with the price of taking responsibility for ones own actions.

Speaking of taking responsibility, here's an idea. Why don't the people reading anonymous comments take the responsibility to judge for themselves the validity of an anonymous comment? It seems like you want to take the responsibility of critical thinking away from the average person and bestow it to the arbiters of truth like newspapers and TV news.

And that is what the waiver can do. It can force the person who lies be held liable.

You might want to re-read the article. The waiver doesn't hold someone liable for lies, it prevents any comments. I think they call that cencorship.

Yeah, like my 80 year old grandma is going to give a flying fuck about trending in public opinion.
She is going to see a bad review and be scared the dude will rape her.

So, because your elderly grandmother doesn't understand the revolutionary change in the way information can now be distributed, we're all supposed to allow our freedom of speech to be limited? Again, if you have a point, you might actually want to make it instead of blathering on about your relatives and leaving the reader to assume what your conclusion is.

I might be wrong, but wasn't there something a few years back about things like this? I'm pretty sure the courts said that a person could not be forced to sign away their First Amendment rights in this manner.

On the other hand, why would you agree to sign such a document, anyways? Seems that the correct response to such a thing would be to refuse and find another doctor. I'm certainly not shy about laying into my doctors when the level of respect is less than should be, after all, it is all about trust. You have to really trust someone to literally put your life in their hands.

If you had read the article you would notice that the company providing these forms suggests that if patients refuse to sign then the doctor should recommend that the patient see another doctor. Outside of emergency situations a doctor has no obligation to treat you.

The other point that seems to be missed here is that doctor's are currently limited by doctor-patient privacy laws so it is often impossible/illegal for a doctor to rebut a false statement made by a patient. Perhaps a better situation would be for the waivers to state that if you provide a public review of a doctor then the doctor has the right to abrogate your medical privacy to rebut the claims being made.

I think doctors should be reviewed and they should use it to their advantage. There are many doctors in the industry that believe that bedside manner is really where it's at to not be sued. I think yelp and other online reviews could be feedback to a doctor that is performing poorly in his bedside manner. If caught early, then they could try to turn their attitude around and prevent possible suits. Maybe over time, reviews could help lower the malpractice suits, lowering malpractice insurance, lowering the costs of medical care. There, I've solved part of the medical cost problem.

Re: Re: Re:

Kevin is not correct. Medicare pays less than other insurance companies and many physicians won't accept it. I know of no specialists who accept Medicaid. Socialized medicine will bring poor quality rationed care. Just talk to the Canadians. I for one will purchase private insurance. Don't think for one second that the politicians will be on the National Health either. The waiver you
mention doesn't prevent any patient from reporting the doctor to the Medical Board etc... or from critical. It is an effort to protect the physician from libel NOT protected speech. The physician cannot enter a written defense of competency without violating HIIPA rights of the patient which carries amoung other things hefty fines.The next site seen will be RateMyNeighbor.com. Then we'll see how the general public likes being libeled without recourse. Maybe someone who doesn't like you will publish your name anonymously (of course) as a sex offender, drunk or child molester. You will, of course, put up with that because it is their First Amendment right to do so. Correct?

Re:

Yelp, for your information, contacted individuals with negative reviews and offered to remove them for a price. Think that's O.K.? These sites exist to make money not to provide accurate ratings of physician competency.

Re: Re: Re: Re:

Re: So much for...

I had a doctor similar to this. He operated me but didn't want to talk/see me after my surgery and when I called him to complaint about discomfort. He just told his nurse to send me a prescription of a double dosage medicine without seeing me!! What a doctor? During my college year, another doctor prescribe me iron pills instead of finding out that I have heart arrhythmia. You would think they know I should have an EKG after 10+ visit. I didn't mean to say all doctors are like that since I've met a few excellent doctors. But how do I find those doctors? It was a trial and error. That is why I launched my own doctor review website so I can share my experience with others and have other to share their experience.

I agreed with this article.

I posted the true horror story of what happen to me on yelp and several websites and it got removed. Now I see fake comments about this quack doctor is allowed. it is ridiculous that us consumer cannot post the truth. Am I glad that are website that allows me to air the truth of what happen to me. I was used as an experiment by a very crooked doctor that got away with scarring my face. I didn't have money to hire a lawyer back then, but I can still share my nightmare with others hoping they will not fall into the same faith with me. No all doctors are created equal and many will lie due to greediness. I am living with loads of noticeable scars on my face. People can tell I got eyelid surgery cuz I have two different size & shape of eyes. My right eyebrow is sagging due to dr. quack removing too much skin from one of my eyelid and pulling it downward. There is approx 1/2" difference between my left & right eyebrows. I have scars all over the place. I am working on to post photos to let people know that doctors are evil.. My face is ruin, but I really hope no one else have to live my nightmare daily.

Re: Re:

Not true. Medicare rates are definitely lower than virtually all private insurance companies. I am a physician in MN and can attest to that. Typically, Medicare reimbursement is about 15 to 20 percent less. Medicaid reimbursement is less than half of what private insurance pays typically, and is not even enough to cover overhead.

Our business has had 5 reviews so far. One is a negative review from a man who is lying about being a client; the other four are very positive. Yelp keeps only the dishonest negative review on our Yelp page, and filters out all positive reviews. Then, after complaining about this, they start hitting me up to set up a "business" account. I will never trust Yelp, again.

Dr. Robert F Allum DO. Gaylord Michigan. Otsego Memorial Hospital.

This creepy doctor Robert F Allum was supposed to do a basic check up on me as a new patient. Because my one medication was a Benzo he started asking personal questions as to my military service, then my personal life. I told him my truthful life experiences, which he could not handle. He couldn't handle the "fact" that I am a famous opera tenor and guitar virtuoso. ( Not the TV fake kind of fame ) He couldn't handle that I had worked for the State Of Florida as an undercover security officer that had arrested hundreds of people. He called me delusional and grandious. This man is sick and evil. Avoid this idiot.

I was a patient of Dr. Allums for several years and he is a wonderful doctor. Very caring and willing to give you all the time you need. Hardly creepy, sick OR evil. I highly doubt he called anyone delusional or grandiose, that is not his style at all. I think the 'Maestro' may be having some issues...

Piece of shit Dr. Robert Allum (Otsego hosp, East Jordon Family Practice, now Cheboygen MICH)

Fuck going to this clown. I was a patient of his at Otsego and he leaves there and does not notify his patients that he left. Neither did the hospital. Dick heads. Then I find he moved to East Jordon Family Medical and I go to him almost a year and a half, then he does the same thing. He leaves without notifying anyone. And again, neither does EJFM. More dicks. And before he worked at Otsego, he worked for his dad in Rogers City. This clown is a looser and a bum. Poor rich kid cant figure out how to work with people and he SUCKS as a fucking doctor. I wouldnt send my fucking dog to this asshole. Fuck you looser. Plus. He is a pussy. He left East Jordon before I could get to him because I was going to fuck him up and maybe still might.

East Jordan Family Health

This place is a fucking joke. Please DO NOT send your family here. They have no idea what they are doing and a lot can be illegal (like certain drugs given patients). The left hand does not know what the right hand is doing.

The doctors "nurses" cover the asses of the dorkters all the time. The dorkters let the underlings cover all the hard patients or difficult patients while the dorkters sit back and let someone else hear all the bullshit.